| NPI | 1114256377 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704199397) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704199397) |
| Enumeration Date | 2009-12-17 |
| Last Update Date | 2020-08-31 |